Assessment and Treatment of the Shoulder Complex

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Assessment and Treatment of the Shoulder Complex
Zac Laraman I.S.R.M.
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• Anatomy Review
• Anatomical Terms and Language
• Functional Anatomy
• Force transmission and dissipation
• Joint Mobility and Stability

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Shoulder Complex

• Scapula (sesamoid)
• Humerus
• Clavicle
• Sternum and ribs
• 4 joints
• (3 true
• 1 functional)

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Shoulder Complex Joints

• Gleno-Humeral Joint
• GHJ
• (anterior view
• Superior GH lig.
• Middle GH lig.
• Inferior GH lig.

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Shoulder Complex Joints

• Acromioclavicular joint
• acromioclavicular lig.
• (anterior view)
• Coracoclavicular Joint
• Conoid Ligament
• Trapezoid Ligament
• cruciate ligaments

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Shoulder Complex Joints

• Sternoclavicular Joint
• sternoclavicular lig.
• costoclavicular lig.
• (anterior view)
• Sternoclavicular Joint
• (superior view)

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Shoulder Complex Joints

• Scapulothoracic joint
• 16 muscles
• Efficiency and imbalance

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Anterior View Bony Shoulder

• Clavicle
• Acromioclavicular Joint
• Acromion Process
• Coracoid Process
• Greater Tubercle
• Lesser Tubercle
• Humeral Head
• Glenoid Cavity/Fossa
• Scapula
• Humeral Shaft

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Posterior View

• Acromion
• Clavicle
• Supraspinous Fossa
• Spine of Scapula T3
• Glenoid Cavity/Fossa
• Infraspinous Fossa
• Head of Humerus
• Humeral Shaft
• Inferior Angle of Scapula
• T7

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Range of Movement
180 deg
0-60 deg

• Flexion Ant. Delt,
• Biceps, Pec. Maj., Coracobr., Serratus Ant.
• Extension
• Teres Maj., Lat. Dorsi, Triceps, Post. Delt.
• Abduction
• Deltoid, Supraspinatus, LH Biceps.
• Adduction
• Pec. Major, LH Triceps, Teres Maj., Lat. Dorsi

0 deg
0-180 deg
180-0 deg
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Range of Movement

• Internal (Medial) Rotation 80 degs
• Subcap., Pec Major, Long head biceps, clav.
  Deltoid
• Teres Major, Lat. Dorsi
• External (Lateral) Rotation 90 degs
• Infraspinatus, Teres Minor,
• Spinal. Deltoid

Internal(Medial) Rotation
External (Lateral) Rotation
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Scapular Movement

• Elevation
• Sup. Serratus Ant.,Levator Scap., Sup. Traps
• Depression
• Pec. Minor, Inf. Traps
• Retraction
• Rhomboids, Serratus Ant., Mid. Traps, Lat. Dorsi
• Protraction
• Serratus Ant., Pec. Minor

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Scapular Movement

• Inferior Rotation
• Serratus Ant.
• Inf. Trapezius
• Superior Rotation
• Sup. Trapezius

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Supraspinatus (Rotator Cuff)

• Prox Supraspinous fossa
• Runs under the AC joint
• Dist Superior Facet of Greater Tub. Humerus
• ActionInitiate Abduction
• (20 30 degrees)

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Infraspinatus (Rotator Cuff)

• Prox Infraspinous Fossa of Scapula
• Dist Post aspect of Greater Tub of Humerus
• ActionExternal Rotation of Humerus together with
  Teres Minor.

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Teres Minor (Rotator Cuff)

• Prox Lat. Border of the Scapula
• Dist Post aspect of Greater Tuberosity of the
  Humerus
• ActionExternal Rotation of Humerus

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Subscapularis (Rotator Cuff)

• Prox Ant. Surface of the Scapula
• Dist Lesser Tuberosity of Humerus
• Actions Internal Rotation
• ( Adduction)

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Dysfunction

• Rotator Cuff strains / impingements
• Adhesive Capsulitis
• Bursitis
• Dislocation / Subluxation

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Assessment

• Observation
• Symmetry (T2, T3, T7, AC), muscle wasting
• Position / Posture (humeral head, scap. sp.)
• Scars, redness, colour
• Palpation muscles, bony.
• Active Movements (all tissues) Scap.Hum.Rhythm
• Active Resisted (contractile)
• Passive (non-contractile)
• Special Tests tissue specific

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Special Tests

• Drop Arm Rotator Cuff
• Empty Can Supra / Infraspinatus
• Napoleon / Lift off Subscapularis
• Apprehension instability
• Scarf AC joint
• Yergason Bicipital tendinopathy
• Ligament sprain / capsule

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